School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia.
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia.
Int J Behav Nutr Phys Act. 2020 Apr 1;17(1):45. doi: 10.1186/s12966-020-00947-2.
Self-selection into residential neighbourhoods is a widely acknowledged, but under-studied problem in research investigating neighbourhood influences on physical activity and diet. Failure to handle neighbourhood self-selection can lead to biased estimates of the association between the neighbourhood environment and behaviour. This means that effects could be over- or under-estimated, both of which have implications for public health policies related to neighbourhood (re)design. Therefore, it is important that methods to deal with neighbourhood self-selection are identified and reviewed. The aim of this review was to assess how neighbourhood self-selection is conceived and accounted for in the literature.
Articles from a systematic search undertaken in 2017 were included if they examined associations between neighbourhood environment exposures and adult physical activity or dietary behaviour. Exposures could include any objective measurement of the built (e.g., supermarkets), natural (e.g., parks) or social (e.g., crime) environment. Articles had to explicitly state that a given method was used to account for neighbourhood self-selection. The systematic review was registered with the PROSPERO International Prospective Register of Systematic Reviews (number CRD42018083593) and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
Of 31 eligible articles, almost all considered physical activity (30/31); few examined diet (2/31). Methods used to address neighbourhood self-selection varied. Most studies (23/31) accounted for items relating to participants' neighbourhood preferences or reasons for moving to the neighbourhood using multi-variable adjustment in regression models (20/23) or propensity scores (3/23). Of 11 longitudinal studies, three controlled for neighbourhood self-selection as an unmeasured confounder using fixed effects regression.
Most studies accounted for neighbourhood self-selection by adjusting for measured attributes of neighbourhood preference. However, commonly the impact of adjustment could not be assessed. Future studies using adjustment should provide estimates of associations with and without adjustment for self-selection; consider temporality in the measurement of self-selection variables relative to the timing of the environmental exposure and outcome behaviours; and consider the theoretical plausibility of presumed pathways in cross-sectional research where causal direction is impossible to establish.
在研究邻里环境对体力活动和饮食的影响时，居民对居住社区的自我选择是一个广泛认可但研究不足的问题。未能处理邻里关系的自我选择可能会导致对邻里环境与行为之间关联的有偏差的估计。这意味着效应可能被高估或低估，这两种情况都对与邻里（重新）设计相关的公共卫生政策有影响。因此，确定和审查处理邻里关系自我选择的方法非常重要。本综述的目的是评估文献中对邻里关系自我选择的概念和解释。
如果文章研究了邻里环境暴露与成人体力活动或饮食行为之间的关联，且包含在 2017 年进行的系统检索中，则将其纳入本研究。暴露可以包括对建成环境（例如超市）、自然环境（例如公园）或社会环境（例如犯罪）的任何客观测量。文章必须明确说明使用了特定方法来解释邻里关系的自我选择。本系统综述已在 PROSPERO 国际前瞻性系统评价注册库（注册号：CRD42018083593）中进行注册，并按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。
在 31 篇合格的文章中，几乎所有文章都考虑了体力活动（30/31）；只有少数文章（2/31）研究了饮食。用于解决邻里关系自我选择的方法各不相同。大多数研究（23/31）通过在回归模型（20/23）或倾向评分（3/23）中多变量调整来考虑与参与者对邻里的偏好或迁居原因有关的项目，来解释邻里关系的自我选择（23/31）。在 11 项纵向研究中，有三项使用固定效应回归控制了作为未测量混杂因素的邻里关系的自我选择。
大多数研究通过调整对邻里偏好的测量属性来解释邻里关系的自我选择。然而，通常无法评估调整的影响。未来使用调整的研究应提供在调整和不调整自我选择的情况下的关联估计；考虑在测量自我选择变量时相对于环境暴露和行为结果的时间；并考虑在横断面研究中，在不可能确定因果关系的情况下，理论上合理的假定途径。
